Isoniazid-induced neuropathy in a pre-pubertal child.

Isoniazid (INH)-induced peripheral neuritis is not uncommonly reported in adults, especially those with malnutrition and alcoholism, but it is very rare in children. INH leads to peripheral neuritis by causing a deficiency in the serum level of pyridoxine which depends on the dose of INH, duration of treatment and the patient's nutritional and acetylator status. A 12-year-old girl developed tingling and numbness of the lower limbs after commencing anti-tuberculous therapy which included INH 10 mg/kg/day. The symptoms continued despite the dose being reduced to 5 mg/kg/day. Nerve conduction velocity was normal. Her diet was poor: she consumed little or no fruit and vegetables and ate mostly dal and rice. Discontinuation of INH was advised and her therapy was changed to ofloxacin, rifampicin, ethambutol and pyrazinamide along with a high dose of pyridoxine and multi-vitamins. The tingling and numbness subsided within 15 days, after which INH was prescribed at the dose of 10 mg/kg/day. Although INH-induced neuropathy is rare in children, the World Health Organization recommends pyridoxine prophylaxis for children on INH who are malnourished or have HIV infection.

Increasing Prevalence of Pediatric Drug-resistant Tuberculosis in Mumbai, India, and Its Outcome.

BACKGROUND: The prevalence and type of Drug resistant tuberculosis (DR-TB) was evaluated pre- and post-2013, and outcome was studied. METHODS: Descriptive retrospective study. Children were defined as having DR-TB on the basis of GeneXpert or line probe assay and/or drug susceptibility testing (DST) of M. tuberculosis grown on culture or from contact's DST. RESULTS: The prevalence of DR-TB was 110 of 1145 cases (9.6%), which showed an increase, compared with 5.6% pre-2010 and 7% in 2010-2013 (P = 0.014408). Twenty-two children (20%) had pulmonary-TB and 88 (80%) had extra-pulmonary-TB with disseminated-TB being the most common presentation in 31 children (28.18%). Ninety-six children (87.3%) were bacteriologically confirmed TB cases, and 14 (12.7%) were clinically diagnosed-TB and treated as per contact DST. Eight cases (7.2%) were monoresistant, 7 (6.3%) polyresistant, MDR-TB seen in 28 patients (25.45%), 32 (29.09%) had pre-XDR-TB, 9 (8.18%) had XDR-TB and 12 (10.9%) were rifampicin resistant. Ethionamide resistance increased from 26.1% pre-2013 to 60.8% post-2013 (P = 0.014408) and ofloxacin resistance rose from 30.4% pre-2010, to 47.6% in 2010-2013 and 56.9% post-2013 (P = 0.080863). Moxifloxacin resistance showed an acute rise from 8.7% pre-2010, to 46% in 2010-2013 and 57% post-2013 (P = 0.000275). Thirty-three patients (30%) had completed their treatment, 21 (19.09%) were lost to follow-up and 56 (50.09%) patients are still on treatment. CONCLUSIONS: DR-TB is increasing in Mumbai, India. Based on the DST results, individualised therapy would be recommended.

Fetal valproate syndrome.

Antenatal use of anticonvulsant valproic acid can result in a well-recognized cluster of facial dysmorphism, congenital anomalies and neurodevelopmental retardation. In this report, we describe a case with typical features of fetal valproate syndrome (FVS). A 26-year-old female with epilepsy controlled on sodium valproate 800 mg/day since 3 years, gave birth to a male child with characteristic features of FVS. She also had 3 spontaneous first-trimester abortions during those 3 years. Sodium valproate, a widely used anticonvulsant and mood regulator, is a well-recognized teratogen that can result in facial dysmorphism, craniosynostosis, neural tube defects, and neurodevelopmental retardation. Therefore, we strongly recommend avoidance of valproic acid and supplementation of folic acid during pregnancy.

Opium intoxication in an infant on Indian folk medicine.

A 45-day-old boy presented with increased drowsiness for a day. His mother was giving the child a mixture of several herbs for the past 15 days for general well-being of the child. Urine analysis revealed the presence of opium and benzodiazepines in the child. On searching through the herbs, opium seeds were identified. The child recovered on his own and needed no antidote.